Headaches & Migraines

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Headaches and migraines are among the most widespread pain-related health problems in both children and adults alike. According to Cleveland Clinic , they are the most common cause of absenteeism from work and school. Migraine sufferers alone lose more than 157 million work and school days in America every year because of headache pain. However, while headaches can be quite debilitating, most are not caused by a serious or life-threatening condition.

Headaches are defined by pain in any region of the head. They may be isolated to a certain location, occur on one or both sides of the head or radiate across the head from one point. Headaches can cause a throbbing sensation, sharp pain or a dull ache.

Some headaches may appear gradually, while others come on suddenly. The duration of headaches also varies, with some lasting less than an hour and others persisting for several days.

This section details more about the various types of headaches and potential causes of both headaches and migraines. If you are worried about your headache symptoms, there is also a comprehensive overview of the danger signs associated with headaches and migraines. For more information about diagnosis and treatment of headaches and migraines, see the last 2 pages of this section.

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Headaches are defined as pain in any region of the head. There are four main types of headaches: tension-type headaches, migraine headaches, cluster headaches and chronic daily headaches.

  • Tension-type headaches cause mild to moderate pain, and pressure or tightness around both sides of the head and neck. People with tension-type headaches, often experience tension or stress before the onset of their headache.
  • Migraines cause moderate to severe pain that is worsened by light, noise or motion. Some people can also experience nausea and vomiting. These typically last between a few hours and a few days.
  • Cluster headaches are severe, debilitating headaches that occur repeatedly for weeks to months at a time, followed by periods with no headache.
  • Chronic daily headache is not a type of headache but a category that includes frequent headaches of various kinds, such as migraines or tension-type headaches. When a headache is present for more than 15 days per month for at least three months, it is described as a chronic daily headache.
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The majority of headaches aren’t the result of a serious illness. Some common causes of headaches are:

  • Alcohol, particularly red wine
  • Caffeine or other drug use or withdrawal
  • Certain foods, such as processed meats that contain nitrates
  • Eating or drinking cold foods or fluids
  • Changes in sleep or lack of sleep
  • Emotional stress
  • Dental problems or procedures, such as pain from grinding teeth
  • Poor posture that causes muscle strain in the neck, upper back or shoulders 
  • Skipped meals or dehydration
  • Exposure to smoke or fumes from chemicals
  • Eye strain
  • High altitude
  • High blood pressure (hypertension)
  • Fever
  • Infection in the sinuses, such as sinusitis or an abscess
  • Premenstrual syndrome (PMS)

Although rare, a headache may be the sign of a serious or life-threatening condition requiring emergency care. Serious conditions such as brain tumors, brain damage, meningitis, stroke or aneurysms may cause headaches. Headaches can also result from injuries to the head and brain, skull fractures and bleeding in or around the brain. Seek medical care urgently if you experience the following symptoms:

  • A sudden headache that feels like a blow to the head or the worst headache of your life
  • Convulsions
  • Headache with high fever
  • Persistent headache following a blow to the head
  • Confusion or loss of consciousness
  • Headache along with pain in the eye or ear
  • Persistent or relentless headache that comes on suddenly
  • Numbness, weakness or paralysis on one side of your body
  • Trouble seeing, speaking or walking
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Despite how common headaches and migraines are, few people require special testing beyond a physical examination and a headache evaluation performed by your doctor. The physical exam involves an assessment of your head, eyes, ears, nose, throat, neck and nervous system. During the headache evaluation, your doctor will consider your medical and headache history, and will ask you to describe your symptoms as completely as possible.

No further tests are needed for obvious tension or migraine headaches. A headache that regularly shifts from one side to the other is also less likely to require further tests, since this suggests a less ominous cause such as stress or fatigue.

On the other hand, if you have pain that consistently occurs in the same location or on one side of the head, this could result from an underlying medical condition such as a tumor and may warrant a more detailed evaluation. If you have just started to experience headaches or your headaches have become worse, your doctor may also recommend additional testing.

If your doctor thinks there might be a problem with the central nervous system, he or she may order a scan using computed tomography (CT) or magnetic resonance imaging (MRI). Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems.

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Successful treatment is tailored to your needs and will depend on several factors, including the type and frequency of the headache and its cause. In many people, headaches can be well controlled with a combination of medicines and complementary therapies. These include education and counseling to identify headache triggers, exercise, stress management, biofeedback, and medications.

  • Headache education: Headache education involves identifying and recording what triggers your headache or migraine, such as lack of sleep, irregular eating patterns, eating certain foods or additives, caffeine, or stress. Once these triggers have been identified, they can be avoided.
  • Counseling: One-on-one counseling, group therapy, or support groups can help you both identify your headache triggers and teach you useful coping techniques.
  • Exercise: Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches.
  • Stress management: Stress management techniques can teach you ways to cope or remove the stressful activities or events. Relaxation techniques include deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, or relaxation to music.
  • Biofeedback: Biofeedback equipment includes sensors connected to your body to examine your involuntary physical responses to headaches, such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. By learning to recognise these physical reactions and how the body responds in stressful situations, biofeedback can help you learn how to release and control tension that causes headaches.
  • Medications: There are three types of headache medications: symptomatic relief, abortive, and preventive medications. According to the World Health Organization , the main classes of drugs to treat headache disorders include analgesics, anti-emetics, anti-migraine medications, and prophylactic medications.
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Try these below tips to help prevent headaches and migraines:

  • Avoid headache triggers: Headaches can be triggered by all sorts of things including stress, caffeine or specific foods. If you’re unsure what could be setting off your headaches, keep a headache diary. Eventually you may begin to see a pattern and be able to take steps to prevent future headaches.
  • Reduce your caffeine intake: Try to minimise or eliminate caffeine from your diet as caffeine can aggravate headaches.
  • Don’t overuse medication: Mayo Clinic maintains that taking headache medication (including over-the-counter medications) more than twice a week can actually increase the severity and frequency of your headaches.
  • Get enough sleep: The average adult needs at least 7 hours sleep a night. Not getting enough sleep can trigger and intensify headaches.
  • Don't skip meals: Start your day with a healthy breakfast and try to eat lunch and dinner at about the same time every day.
  • Exercise regularly: Regular aerobic exercise can reduce tension and help to prevent headaches and migraines. With your doctor’s OK, choose aerobic activities you enjoy. Warm up slowly, however, because sudden, intense exercise can cause headaches. Regular exercise can also help you maintain a healthy weight, as obesity is thought to play a role in migraine headaches.
  • Relax and reduce stress: Stress is a common headache trigger, with most headaches caused by stress ending when the period of stress is over. Try yoga, meditation or relaxation exercises to slow down. Set time aside to do the relaxing activities you enjoy, such as reading and listening to music.
  • Reduce the effects of estrogen: If you're a woman and estrogen seems to trigger or worsen your headaches, you may want to avoid or reduce the medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the appropriate alternatives or dosages for you.
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